Mania

In this episode, Wendy discusses mania and has some suggestions as to how to cope with a manic episode.

Wendy's novel on psychiatric hospitalizations is out on Amazon! It's called "Involuntary Hold." Check it out~ There is a plot twist you won't see coming!



International Helpline Info

 For those living outside the United States, I finally found some helpful information. The International Association for Suicide Prevention has a directory of crisis centers and helplines for over 50 countries! 

Just got to the internet and type in:

       findahelpline.com/i/iasp

 And it will bring you to a drop-down menu where you can input your country and region, and it will give you the information for your location. Granted, it doesn’t cover everywhere, but it’s a start!

** Remember if you, or a loved one, is in emotional crisis... Help is just a phone call away. Simply dial 9-8-8 for the Suicide and Crisis Hotline, or text "HOME" to 741741 to chat with someone via text 24/7 across the United States. **

Please contact us at bipolarforlife@myyahoo.com with any questions, suggestions, or comments.

Transcript

Bipolar for Life

Episode 8—Mania

Since antiquity, scholars have described the symptoms of mania and its associated illnesses. Hippocrates and the Hippocratic School are widely credited with the first description and classification of mania.

In the second century A.D.,  Aretaeus of Cappadocia described the possible relationship between mania and depression. 

In 1854, Falret described manic-depressive disease in his “Memoir on Circular Insanity”, and in 1899, Kraepelin delineated mania from other psychoses and coined the term manic-depressive insanity. 

 Welcome to Bipolar for Life, a show dedicated to survival. This podcast examines the day-to-day struggles with this life-threatening mental illness.

 I’m your host, Wendy Foard, and I have lived with bipolar disorder for 43 years now; it hasn’t always been pretty—I’ve survived several suicide attempts, four psychiatric hospitalizations, and one disastrous trip to rehab. Yet, I’m still here!

 Let me say at the outset that I am NOT a medical doctor. I am simply a seasoned manic depressive, trying to help others survive this deadly condition through information and shared experiences. 

 Tonight, I thought it was time to talk about the fun part of being bipolar—Mania. Well, fun to a point… as with everything regarding bipolar disorder, there is always another side to it.

 The Diagnostic and Statistical Manual of Mental Disorders volume 5, or DSM-5, defines mania as being a distinct period of abnormally, and persistently elevated, expansive, or irritable mood with persistent goal-directed activity or energy.

 But if you ask most people with bipolar disorder, they will tell you it’s the best time of their lives. It has been for me! It’s a time when you have unlimited energy, anything is possible, and life is truly wondrous! The need for sleep and food is severely diminished, for frenzied energy and ideas consume all your time. But the best part is the feeling that you can do anything you put your mind to, and your dreams are within your grasp!

 The saddest cut of all is that mania is but a fleeting moment in the sun. Like the phoenix, the flames of your own brilliance consume you. Your body cannot run without sleep or food, and thus begins to break down. It’s at this point that hospitalizations most often occur, for hallucinations and delusions are common as your body battles your mind for control.

 According to a 2021 study, manic episodes last approximately 3.5 months on average. For people not receiving treatment, a manic episode can last from 3 to 6 months. However, with effective treatment, an episode may end in under 3 months. 

 The DSM-5 states that an episode of mania involves, at least, 3 of these behavior changes:

 1)Elevated self-esteem, high self-confidence, or feelings of grandiosity—This symptom is a boost in uncritical self-confidence. For example, it might look like taking on projects without any particular experience, such as beginning a novel without any writing background, or seeking publicity for an invention without thinking through all the details. 

2)Less need for sleep; feeling rested after only a few hours of sleep—You might wake up several hours earlier than usual, but still feel full of energy. When this is severe, people can sometimes go days without sleep and still not feel tired.

 3)Fast, loud and sometimes disorganized speech, or feeling a pressure to keep talking—You may feel like talking continually even if others are unwilling to communicate. Jokes, puns, dramatic mannerisms, and singing are all common. You, or those around you, may notice a mode of speech known as clanging. This is where you link words together based on their sound rather than their meaning. Compulsive rhyming and alliteration are also common.  However, if your mood is more irritated than elevated, your speech may be pocked with complaints, anger, hostile comments, or just plain rants.

4)Racing thoughts or quickly changing ideas—Your thoughts may race at a much faster pace than they can be articulated during a manic episode. Some people say it’s like watching 3 or 4 TV shows at the same time. You can also have a “flight of ideas,” which is a nearly continuous flow of fast speech with abrupt changes from one topic to another. When this symptom is severe, your speech may seem disorganized or be difficult to follow. 

 5)Feeling easily distracted or unable to pay attention to one thing for long—You may lose attention easily and end up focusing on irrelevant objects. For instance, during a conversation, you might find your attention is drawn to background noises, or objects in the room, rather than the conversation you’re having. It can also be more difficult to differentiate between thoughts that are linked to the conversation and thoughts that are only slightly relevant, or not relevant at all.

6)Doing many activities at once, such as work tasks, organizing social events, or seemingly purposeless movements—It’s common to overextend yourself during mania; taking on many activities or projects even when you’re not always able to finish them. You might find yourself working on projects at all hours of the day and night with little sleep or rest. 

You may feel extra social, renewing old acquaintances, or call friends (even strangers!) sometimes at odd hours of the day or night. Hypersexuality, or an increased drive towards sexual activities, can also occur in mania. Finally, you might feel restless or agitated, moving around more than usual, or holding multiple conversations at the same time, over the phone and in person.

 7)Engaging in activities on impulse that can lead to harmful consequences—The expansive feelings, elevated self-esteem, and grandiosity you experience can sometimes lead you to engage in activities that have harmful consequences, such as overspending money, heavy alcohol or drug use, or dangerous driving. Typically, you won’t realize the harm these actions can cause at the time. 

 These symptoms can become severe enough to get in the way of your life and functioning. They might cause problems at work and home, such as job loss, financial losses, and difficulties in relationships. 

 There are four common types of mania:

Euphoric: Euphoric mania is a condition many describe as incredible, beautiful, unbelievable, fantastic and expansive. This experience is often welcomed at the onset.

 Dysphoric: Dysphoric mania is a varied experience a combo of mania mixed with agitated depression. People often describe this as if they are coming out of their skin, or their mind and body are at civil war.

 Hypomania: A hypomanic episode is one in which you experience symptoms similar to mania but to a lesser extent of intensity. Essentially, one’s mood is elevated but not to a full-blown manic episode. According to the DSM-5, hypomania is distinct from mania in that there is no significant functional impairment, while full-blown mania does include significant impairment and may have psychotic features. Hypomania is a characteristic of Bipolar II Disorder.

 Psychotic: Psychotic mania is a condition in which you experience delusions or hallucinations. Delusions are irrational, inconsistent beliefs that seem true but are unrealistic. A delusional person might become extremely paranoid and believe someone is out to harm them. Or, they could have an exaggerated sense of self-confidence, power, talent, or importance.

Hallucinations are sensory illusions. For example, someone experiencing a psychotic episode may hear voices, see people who aren’t there, or feel unusual sensations.

 Professionals who specialize in diagnosing and treating psychosis have not identified what causes it. However, manic psychosis is actually a feature of several different mental health conditions, such as Bipolar I Disorder, Seasonal Affective Disorder, Postpartum Psychosis, Schizoaffective Disorder and Cyclothymia.

 Bipolar I Disorder is the most common condition for manic psychosis to occur. This type of bipolar disorder gets extremely high and devastatingly low in mood swings and energy levels. 

Seasonal Affective Disorder, or SAD, occurs when  the seasons change. Many people with SAD struggle in the fall and winter, though it’s possible to have it in the warmer seasons as well.

 Postpartum Psychosis is a severe mental health challenge that affects some women after giving birth. It involves symptoms such as lethargy, trouble bonding with the newborn, irritability, and thoughts of self-harm. 

 Schizoaffective Disorder. People with this disorder may experience depression, mania, and psychosis. 

 Cyclothymia is a milder form of bipolar disorder involving less severe mood fluctuations. 

 The best thing about mania to me, as I grow older, is not only the energy boost, but the elimination of the everyday aches and pains. I don’t feel creaky at all in mania, but in depression those pains are multiplied 100 times. 

 The onset of mania is often a breath of fresh air compared to the periods of severe depression, suicidal ideation, and social withdrawal. But as the condition intensifies, it often presents us with undesirable effects. The dark side of mania is called dysphoria. Dysphoria in bipolar disorder is characterized by increased energy and activity, as seen in euphoria, but the mood is dominated by excessive and persistent irritability. Agitation and restlessness often accompany irritability. 

 It is not uncommon for a person with bipolar disorder to start in a euphoric state but eventually become dysphoric as the episode persists. 

Episodes of mania can be different from person to person. You might feel really great, like you’re on top of the world and can do anything, or you might be extremely irritable instead. Symptoms may become severe enough to require hospitalization, for people often find it exceedingly difficult to sleep during mania. This can end up having a serious impact on work and social life. Also, during mania, people may do things without thought for the consequences, like taking risks with their physical safety. 

 So, we now know what it’s like to surf the tsunami of emotion and energy, but how do you know when the ride is over? Basically, things wind down, or you crash. If you wind down, you’ll notice things like feeling less urgent about everything or less pressured all the time. You’ll feel more tired and get more sleep. You’ll be able to think more clearly, even if your memories of the manic episode itself seem fuzzy. And you’ll make fewer impulsive decisions. Often, you’ll feel overwhelmed by the number of projects you’ve taken on and embarrassed by your behavior during the episode. Feeling low or depressed after a manic episode is not uncommon. 

 Now, I mentioned these feelings could come on gradually, or you could just crash. Crash is not a psychological term, it’s one I use to describe what happens to me after a major manic episode. I basically sleep for 3 days straight without moving.

  I guess my body just reaches the point of pure exhaustion and it shuts down. It’s almost an anti-manic episode because I don’t eat or move. All I do is sleep. In fact, the sleep is so deep that it’s virtually impossible to wake me. It takes me several months to come out of one of these crashes. I’m lethargic, slow-witted, and feel as if I’m under water. My perceptions, speech, and actions are all slower when I first come out of the crash.

 I liken the reawakening to turning on a large computer… you turn on a few components and wait for them to warm up. My switches are slow as well. Eventually, I come back to myself on a relatively even keel. Then, when the deep winter arrives, so does the dreaded depression, and the cycles of a bipolar life… continue.

 In my research for this show, I found some tips on preventing a manic episode from the International Bipolar Foundation. They suggest:

1)Reach out when you notice signs of an impending episode—Talk with your doctors and reach out to family and friends. Catching mania early can prevent the episode from worsening. 

 2)Avoid using alcohol and other substances—These can interact with your medications and affect moods

 3)Be patient with yourself and finding the right treatment—Finding the right medications and coping skills can take some time. Be gentle with yourself.

 4)Take it one step at a time—Remember, several small steps add up to one large one. Some small steps might involve setting up a sleep routine, talking with a friend for support, or reaching out to a mental health professional.

 5)Find support—Join a support group where you can talk with others about your experiences. If you’re like me and live in a rural area, the internet is a good place to find a support group. 

 6)Try stress management techniques—Relieving stress can boost your overall well-being. Some go to options are exercise, meditation, yoga, or gardening.

 7)Accept help—It can take some practice accepting help from others, but getting the right support from loved ones and professionals is essential to avoid the negative consequences of an uncontrolled mania.

 8)Set up an emergency action plan—This is a safety plan that can be used in a crisis. Create lists of resources (doctor’s phone numbers, medications list, insurance numbers, etc.) and coping strategies to use when you need them.

 9)Get quality sleep—Getting enough sleep, maintaining good sleep habits, and creating a quiet, dark sleep environment can all benefit your mental health.

 Many of these suggestions may sound familiar, for they overlap with other topics we have discussed, like depression and anxiety. In fact, the medications you take for mania may sound familiar, as we have spoken of them in Rapid Cycling. 

An acute manic episode is often treated with an antipsychotic such as Abilify, Latuda, Risperdal, Seroquel, Vraylar, or Zyprexa. While long-term treatment may include mood stabilizers to prevent future episodes, such as Depakote, Lithium, and Tegretol.

 It is important to continue with your treatment plan, no matter how good you might feel during a manic episode. While you might feel like you no longer need meds, when the episode is over, stopped meds can have very unpleasant side effects.

 After a manic episode, it is important to get back to your regular routines for eating, sleeping, and exercise as soon as possible. Take care of yourself! You’ll need a little TLC after a full-blown episode. 

Managing bipolar disorder and mania can be tricky, but with trial and error, you can find the best ways to cope. The signs of a manic episode are different for everyone. Taking the time to know your warning signs can help you feel more in control when they arise. For example, I know mania is on its way when I find my right knee bouncing on its own. 

 Mood tracking is a great way to do this. They have apps for that now or writing in a journal works well for some people. You might also find it helpful to ask loved ones and friends to let you know when they notice any signs of mania, because you may not always be aware of it when it’s happening. Watch out for situational triggers such as staying out late, listening to loud music, starting a new project, or going on vacation. 

Other triggers to watch out for are high levels of stress, lack of sleep, significant life changes like moving or going through a divorce. There are many other so-called triggers, but each mania is unique, and it’s not always the same trigger that starts it off. So, tracking it over time can help you map out possible future triggers. 

 I hope this information has been helpful, rather than confusing. Basically, mania is a great thing up to a point, then… it becomes dangerous because of the harm you can do to yourself and others without intention. 

 If you find yourself feeling out of control, or feeling like you need to harm yourself, please don’t hesitate to get help! Just Dial 9-8-8 and speak to someone at the Suicide and Crisis Lifeline, or if you’d rather not speak directly to someone, you can always text H-O-M-E to 741741 to reach a crisis counselor. 

 As always, please contact us at bipolarforlfe@myyahoo.com with any concerns, suggestions, or complaints. We won’t read them on the air! But I would love to hear from you! Please let me know how you like the show, and what we can do to improve your experience. Are there any topics you’d like more information on? Or would you rather that we chat more about experiences? Please take a moment and let me know your thoughts at bipolarforlife@myyahoo.com. 

 Well, that’s all the time we have for tonight. Join me next time on Bipolar for Life when we discuss self-medication and addiction. Please be safe in all your travels. Good night!